Cost Effectiveness of TNF-α Inhibitors in Rheumatoid Arthritis.

Background. TNF-α inhibitors have shown to be effective in reducing disease activity and improving the quality of life. Due to the high costs associated with acquisition of this treatment, this study was undertaken to evaluate the ICER of TNF-α antagonists (etanercept, adalimumab, and infliximab) in improving the quality of life. Methods. The HAQ and SF-36 were administered at phases 1, 2, and 3, in order to assess the improvement in the QOL. Suppression of disease activity was assessed through the DAS-28. Results. Statistically significant improvements (P < 0.05) were noted for the SF-36 and HAQ after 3 months and for the DAS-28 after 6 months of TNF-α inhibitor therapy. The mean ICER per 10% improvement in the HAQ, DAS-28, and SF-6D were €1976.5, €2086.5, and €2316.4, respectively, following 6 months of TNF-α intervention. Most favorable ICERs were reported from a patient who had to undergo surgical intervention whilst on DMARD therapy. Conclusion. Significant improvement was observed in patients' quality of life, after a short timeframe of 6 months. Such data is useful information in the light of convincing policy makers, in terms of providing access to the medications to individual patients on national health service schemes.

Impact of drugs counselling by an undergraduate pharmacist on cardiac surgical patient’s compliance to medicines / Impacto del consejo sobre medicamentos por un estudiante de farmacia en el cumplimiento de pacientes bajo cirugía cardiaca

Open heart surgery is a procedure which warrants patient education about the complexity of drug regimens and lifestyle modifications. Patient nonadherence is likely to have a considerable negative impact on the patients’ quality of life postcardiac surgery. Objective: To evaluate the impact of pharmacist intervention on patients’ adherence to medication and lifestyle changes. Method: This case-controlled study was conducted at the Cardiac Surgical Ward and Outpatients Clinic of Mater Dei Hospital, Malta. Eighty consecutive patients who underwent coronary artery bypass or heart valve surgery were interviewed on their day of discharge using the ‘Past Medical History Questionnaire’. The patients were then randomized to receive pharmacist intervention or usual care. Those who received intervention (40 patients) were given a chart with pictorial explanation of the time of day together with a colorful photograph of each tablet prescribed. This group of patients was also counselled to comply to oral analgesia and exercise and also on the avoidance of alcohol and smoking during the recovery period. The control patients received usual care without the pharmacist intervention. All patients were re-interviewed eight weeks after discharge using the ‘Assessing Patient Compliance Questionnaire’. Any differences between the control and experimental groups were analysed using Chi-square, Three-Way Cross tabulation One-Way ANOVA and Two-Way ANOVA tests using the SPSS software version 17.0. Results: A statistically significant difference between the two groups in the mean percentage compliance was registered following pharmacist intervention (p<0.05). Patients in the experimental group had a higher mean percentage compliance score (88%) than patients in the control group (66%). Conclusion: The statistically significant difference in the mean percentage compliance between the two groups following pharmacist intervention shows conclusive evidence of the advantage patients gain when offered this intervention. The pharmacist intervention provides patients with sufficient information to help them achieve optimal benefit from the medication prescribed (AU)

La cirugía a corazón abierto es un proceso que agradece la educación a pacientes sobre la complejidad de los regímenes farmacoterapéuticos y modificaciones de estilos de vida. El incumplimiento del paciente puede tener un impacto negativo considerable sobre la calidad de vida de los pacientes post-cirugía cardiaca. Objetivo: Evaluar el impacto de la intervención farmacéutica sobre la adherencia a la medicación y el cambio de estilos de vida. Método: Este estudio caso-control fue realizado en el servicio de cirugía cardiaca y clínica ambulatoria del Hospital Mater Dei, Malta. Se entrevistó en el alta, utilizando el ‘Past Medical History Questionnaire’ a 84 pacientes que sufrieron by-pass arterial coronario o cirugía de válvula cardiaca. Se aleatorizó a los pacientes para recibir intervención farmacéutica o cuidados habituales. A los pacientes intervención (40 pacientes) se les dio una tabla con explicación pictórica de la hora del día a la que deberían tomar cada tableta prescrita junto con una fotografía a color. También se aconsejó a este grupo de pacientes que cumpliesen con la analgesia oral y el ejercicio y también que evitasen el alcohol y el Tabaco durante el periodo de recuperación. Los pacientes control recibieron cuidados normales sin la intervención del farmacéutico. Se entrevistó a todos los pacientes 8 semanas después del alta utilizando el ‘Assessing Patient Compliance Questionnaire’. Las diferencias entre los grupos control e intervención fueron analizadas usando tests chi-cuadrado, tablas cruzadas de res vías, ANOVA de un factor y ANOVA de dos factores, utilizando el programa SPSS versión 17.0. Resultados: Se registró una diferencia significativa entre los dos grupos en el porcentaje medio de cumplimiento después de la intervención farmacéutica (p<0,05). Los pacientes en el grupo experimental tuvieron un mayor porcentaje de puntuación de cumplimiento (88%) que los pacientes control (66%). Conclusión: La diferencia estadísticamente significativa en la media de porcentaje de cumplimiento entre los dos grupos después de la intervención del farmacéutico demuestra una evidencia conclusiva de la ventaja que obtienen los pacientes cuando se les ofrece esta intervención. La intervención del farmacéutico proporciona a los pacientes suficiente información para ayudarles a alcanzar beneficios óptimos de la medicación prescrita (AU)

Impact of drugs counselling by an undergraduate pharmacist on cardiac surgical patient's compliance to medicines.

UNLABELLED: Open heart surgery is a procedure which warrants patient education about the complexity of drug regimens and lifestyle modifications. Patient nonadherence is likely to have a considerable negative impact on the patients' quality of life post-cardiac surgery. OBJECTIVE: To evaluate the impact of pharmacist intervention on patients' adherence to medication and lifestyle changes. METHODS: This case-controlled study was conducted at the Cardiac Surgical Ward and Outpatients Clinic of Mater Dei Hospital, Malta. Eighty consecutive patients who underwent coronary artery bypass or heart valve surgery were interviewed on their day of discharge using the 'Past Medical History Questionnaire'. The patients were then randomized to receive pharmacist intervention or usual care. Those who received intervention (40 patients) were given a chart with pictorial explanation of the time of day together with a colorful photograph of each tablet prescribed. This group of patients was also counselled to comply to oral analgesia and exercise and also on the avoidance of alcohol and smoking during the recovery period. The control patients received usual care without the pharmacist intervention. All patients were re-interviewed eight weeks after discharge using the 'Assessing Patient Compliance Questionnaire'. Any differences between the control and experimental groups were analysed using Chi-square, Three-Way Cross tabulation One-Way ANOVA and Two-Way ANOVA tests using the SPSS software version 17.0. RESULTS: A statistically significant difference between the two groups in the mean percentage compliance was registered following pharmacist intervention (p<0.05). Patients in the experimental group had a higher mean percentage compliance score (88%) than patients in the control group (66%). CONCLUSIONS: The statistically significant difference in the mean percentage compliance between the two groups following pharmacist intervention shows conclusive evidence of the advantage patients gain when offered this intervention. The pharmacist intervention provides patients with sufficient information to help them achieve optimal benefit from the medication prescribed.

Development of protocols for the provision of headache and back-pain treatments in Maltese community pharmacies.

OBJECTIVE: The purpose of this study was to draw up two protocols designed to help Maltese pharmacists care for consumers seeking treatment for headache and back pain and to subsequently use the protocols to assess pharmacists' management of the named conditions. METHOD: The setting was a sample of 10 of the 207 community pharmacies in Malta. Two flow-chart protocols for headache and back-pain management were developed from various reference sources. The protocols were first tested in a community pharmacy for practicality and applicability in a pilot study. In nine other pharmacies chosen at random the pharmacists' manner of addressing 10 headache and 10 back-pain cases in each pharmacy was compared with that recommended in the protocols. Consumers who visited the pharmacy to fill a prescription, to purchase a named product or for advice on how to deal with symptoms were included in the study. KEY FINDINGS: Of the 212 pharmacist interventions assessed, cases where pharmacists responded to symptoms were managed with the highest average compliance (57%) whereas cases in which the consumer asked for a product by name were managed with an average compliance with the protocols of 46%. Cases in which consumers presented at the pharmacy with a prescription were managed with an average compliance of 55%. CONCLUSIONS: Protocols may be used as a means of measuring the impact of the intervention of community pharmacists in patient care. The findings suggest a lack of advice given to consumers presenting at the pharmacy to request a named product.